Mental Illness Perceptions in the Somali Community in Columbus, Ohio

Burhan Ahmed, MPH

Master Candidate Certified Application Counselor

Columbus Neighborhood Health Center

The Somali Community in Columbus

• An emerging community

– Somali Community population 30,000

• Refugee background

– social and political upheaval

– majority enter through Humanitarian Program and Family Reunion

• Culturally distant

– traditional African

– Islamic

Somali Refugees in U.S.

• Cities in:

• Columbus

• Minneapolis

• Atlanta

• Boston

• San Diego

• Portland ME

What does it mean to be a refugee?

• Foreign-born resident who:

• is not a United States citizen

• cannot return to his or her country of origin because of a well-founded fear of persecution due to race, religion, nationality, political opinion, or membership in a particular social group

• Refugee status is generally given: • prior to entering the United States • by the Bureau of Citizenship & Immigrant Services (USCIS)

• Eligible for up to 8 months of public assistance.

U.S.A.

U.S. Citizen Non-Citizen

Persons fleeing from persecution

LPR

Immigrant

LTR authorized

employment

Non-Immigrant

student tourist

refugee asylee parolee

undocumented

individual visitor on

business

8/03

USCIS Definitions

What does it mean to be an immigrant?

Foreign-born resident who:

• is not a United States citizen

• is defined by U.S. immigration law as a person lawfully admitted for permanent residence in the United States

• either arrives in the U.S. with an immigrant visa issued abroad, or adjusts their status in the U.S. from temporary to permanent resident

• may be subjected to a numerical cap

Mental Health Needs

• Many Somalis experienced torture themselves or witnessed torture first hand in Somalia

• This experience has left mental scares that negatively affect their mental well being.

– Their mental health problems are exacerbated due to

• Social, economic and cultural factors

• Mistrust of mental health providers who do not respect, or are incompatible with the culture of the people they serve creates a barrier to seeking medical attention

• The overall stress of being a new country contributes to more stress .

Looking at Themes (Deductive/Inductive)

• Somali Culture

• Loss, Trauma

• Clan, Islam,

• Traditional African, Jinn

• Settlement Issues

–Different culture

– Isolation

–Separation

–Practical problems

– Inter-generational conflict

– Language difficulties

– Financial problems

–Unemployment

–Preoccupation with country of origin

Continuous

• Unemployment

• Preoccupation with Country of origin

• School problems

• Expectations not fulfilled

• Family reunion difficulties

• Negative host attitudes

• Qualification not recognized

Best Practice for Leading to Somali Person in Mental Health Clinic are:

• In general, individual are best served by professionals from their cultural or ethnic group

• Somali community need to obtain services from Somali professionals who best understand their culture dynamics and behaviors

• It is important that someone from the cultural group be included in the decision making

Thank You

Ohio Department of Mental Health and Addiction Services’ (OhioMHAS)

Somali Mental Health Services

Demographics Served

• Females

• Ages (18-50 years old)

• Married with children

• Low income household

• Somali speaking

• Reside in Franklin County

Most Common Reason for Seeking Services

• Depression

• Psycho-somatic

• Anxiety

• PTSD

• Acculturation Problems

• Child/Parent problem

Referral Sources

• Family Physicians/PCP

• Family members

• Pervious clients

• Clients are more likely to follow through with obtaining counseling services if they have a rapport with the referral sources.

Cultural Barrier to Seeking Services

• Potential service seekers are afraid of being stigmatized as a crazy, weak or lack faith.

• Not understanding the purpose of mental health and counseling.

• Believing that they can resolve their issues on their own.

• Counseling is perceived as a waste of time.

General Barriers to Service

• Transportation

• Not being aware or able to identify their problems.

• Lack more imminent basic needs such as adequate housing, employment and other resources.

Consumer Engagements

• Bi-Lingual Direct Service providers when possible.

• In the event that interpreters are utilized, interpreters have to be extremely confidential and in-house.

• Community education

Service Retention

• Creating service plans with beginning, middle and ending with consumers’ input.

• Assisting and empowering consumers to utilize other community services to help meet their own needs that are beyond our scope of practice.

November 19, 2014

By Mahdi Warsama

In general, Somalis are mentally resilient

due to their tough nomadic background

combined with the harsh semi-desert climate

of Horn of Africa

Post-traumatic stress, depression and

anxiety disorders are common mental health

problems experienced by some Somalis who

personally witnessed horrific civil war

atrocities such as killing, rape, and torture

Undiagnosed mental illness is very common

among the community

There is an stigma amongst Somalis about

seeking help for mental and behavioral health

Somalis do not have the same conceptual

understanding of mental health as Western

culture

Mental health illness such as depression and

anxiety, are not generally recognized as sickness,

rather, they are considered a social problem

Buufis is a general term for mental health

conditions such as depression and it has a

negative connotation in Somali lexicon

Many Somali children (and/or their parents)

may have lived in refugee camps, potentially

exposing them to the atrocities of war

including, rape, torture, murder, lack of

food, water, and shelter

This may make them more vulnerable to

symptoms of trauma

Cultural conflict, adjustment problems,

identity crisis, and lack of acceptance from

the host community has resulted in mental

illness among the teens

Provides culturally-specific intensive and

non-intensive clinical and case management

services

Somali speaking team members provide

interpretation, consultation,

training/education services to internal and

external families

Provides support for Somali youth (5-18) and

families struggling with symptoms related to

loss, trauma, resettlement, and merging of

the two cultures

Engagement and trust building is more important than any service delivery

Utilization of family strength will produce much better outcome than one-sided treatment

Approaching the family problems holistically is necessary rather than dealing with the individual client

Providing acculturation services in the areas of education, legal, housing, and immigration for the whole family will mitigate the problem much faster

Language barrier

Stigma about mental health itself or the fear

of stigmatization if the person seeks help

Lack of knowledge of healthcare system

navigation in general

Scarcity of culturally appropriate mental

health services

School/Education: school navigation, truancy prevention, after school tutoring, inadequate/underutilized ESL services, parent involvement problems,

Parenting/Domestic Challenges: lack of parenting skills suitable to the US, misunderstanding about parent rights and responsibilities, unruly teens with single parent house holds, inadequate supervision of children and high crime neighborhoods, parent child conflict due to cultural differences and expectations

Always provide Somali interpretation whenever and wherever it is necessary

Provide Somali culture competency training to your employees.

Use culturagram to know more about your clients.

Hire a community liaison where it is needed and warranted

Provide acculturation and resource navigation services by connecting the families to other service providers and resources

Length of time in the community

Reason for relocation or immigration

age and time of relocation or immigration

Languages spoken

Health and mental health beliefs and

practices

Pregnancy and childbirth practices

Child rearing practices

Attitudes about early childhood mental

health

Family constellation/size

Living environment

Number of caretakers and relationships

Social supports and linkage to the community

Family values

Stressors or crisis events

SOMALI CULTURE Mental Health in context of Somali

Culture

HISTORY OF SOMALI

Who are Somalis?

Where do they come

from?

Why are they here?

Culture & beliefs

How is Mental illness

treated?

WHO ARE THEY? Somalia is located the horn of Africa

Somalis are black and 99% Sunni Muslims.

Somali is the official language -two major

dialects ( Maay and Mahaatiri )

The Somali population is 8-10 million (not

included are ethnic Somalis in Ogaden

region of Ethiopia, Northern frontier district of Kenya, and the republic of Djibouti

and other parts of Eastern Africa).

Mogadishu is the capital of Somalia

70%-80% Somalis hail from a pastoral,

nomadic life.

The rest are farmers, work in fishing communities, and traders/merchants.

WHY THEY ARE HERE?

One of the poorest country in the world

Literacy is low. Many can not read or write

their native language.

For the last century, Somalia has

experienced very rapid urbanization,

people began moving to nearby cities,

where they found manual jobs or stayed

with relatives that were already living in the

cities.

During the past 24 years Somalia has been

enduring civil instability

Columbus is home to many Somalis(Second

largest Somali population in the United

States)

Many are from refugees camp In Kenya

and Ethiopia.

WHAT ARE THE CULTURAL

BELIEVES OF MENTAL ILLNESS?

Mental Illness is rampant in

Somalia

Country has no healthcare

system ( lack of patient

history)

Do cultural beliefs hinder or

help? example;

(postpartum)

Stigma surrounding mental

illness people do not seek

treatment

How do they frame mental illness?

Mentally ill person is possessed by

angered spirits (jinn), lack of faith,

has an evil eye, or bewitched .

Traditional treatment include ritual

ceremonies, herbal treatments

reading verses of the Quran over

the ill person

(personal story)

WHAT ARE THE CULTURAL

BELIEVES OF MENTAL ILLNESS?

WHAT DO I DO?

Columbus City Attorney Office Domestic

Violence and Stalking Unit:

Assigned to Judge Tyack’s courtroom

advocate

Any cases where the victim is

Somali/Muslim

Help victims of DV in court process

Provide referrals Internal and External(

Legal services, food, Shelter, counselling

resources, crime compensation

program)

Columbus City Attorney Office

Domestic Violence and Stalking Unit:

Liaison between the prosecutor

and the victim

Advice prosecutor cases regarding

cultural issues

Student at Ohio State College of

Social Work- graduating Spring of

2015 with MSW degree (Mental

health and substance abuse track)

WHAT DO I DO?

MENTAL HEALTH/SUBSTANCE

ABUSE Many diagnosed/undiagnosed mental

Illness in Domestic Violence cases.

Some stop taking medication while

others self medicate with substances

Khaat is one of the most common

substances they abuse

Others use poly substances including

alcohol and drugs

Mental health court is an option

Bizarre stories in intake process (Mental

illness)

Some cases are DSM due to

competency issues

BARRIERS TO SERVICES

Language/Cultural barriers

Mistrust of mental health care

system

Social isolation

Lack of mental health services in

their country of origin

Misdiagnosis

Fear

Stigma

Contact Info

Ayan Hassan, Somali Outreach

Advocate

City Attorney Rick Pfeiffer’s Office

Domestic Violence & Stalking Unit

375 S. High St., 17th Floor

Columbus, OH 43215

(614)645-0319

ashassan@columbus.gov;hassan.49

@osu.edu